Fighting for independence: NPs vs. the 50 states

The Pennsylvania legislators have finally seemed to get on board with nearly half of our 50 states to break the cumbersome bonds of collaborative agreements.  Right now, nurse practitioners are being forced to practice under a two-physician contract agreement in order to give routine care to Pennsylvanians who desperately need medical care.

This desperation stems from two things.  First, the health care system has been and continues to be in a state of shambles.  Second, and most urgent, is the little-known fact that the nearly 11,000 nationally certified nurse practitioners in Pennsylvania are being held to a decades (decades!) old law that requires NPs to “collaborate” with not one, but two physicians in order to practice.  There are about 38,000 active physicians in Pennsylvania (General Assembly of the Commonwealth of Pennsylvania, 2015, p. 11).  Many physicians do not want to be bothered with the cumbersome paperwork slowly, ever so slowly processed by the Pennsylvania Board of Nursing.  Although the website states two weeks, it is more like two months to process.

Worse yet are physicians who never step foot into an NP-led practice, typically in rural areas, but they are named as collaborators.  And the NPs pay on average $5,000 annually each to those physicians just for a signature.  It’s like being held hostage but never getting the resolution.

Should one of those “collaborative” physicians retire, fall terribly ill (think stroke), or die, the nurse practitioner must stop practicing.  I personally know an NP who owned her own clinic in a rural area and did house calls when one of her collaborative physicians had a stroke and retired.  No warning. It just happened.  And until she found another doctor to agree to sign on, she had to close her practice.  Three weeks.  Closed.  Patients had no care for three weeks. Tell me, after over 15 years of practicing, how is that fair?  Will her mortgage company cut her a break?  Her light and power company?  No.  Not any more than that Commonwealth of Pennsylvania.

Fortunately, the legislators of the great Commonwealth of Pennsylvania have passed SB717 and now it will head to the House of Representatives.  The Pennsylvania Coalition of Nurse Practitioners (2017) states, “Senate Bill 717 and House Bill 765 would end this costly, arbitrary and outdated mandate and make Pennsylvania a full practice authority state.”

Already, 21 other states plus the District of Columbia have granted full practice authority to their NPs.  However, Pennsylvanians in rural and underserved areas may soon be able to rejoice as NPs who have completed an unprecedented three-year “training period” and 3,600 hours under the aforementioned collaboration agreement would be able to apply to work independently.  (One can only imagine how many months it will take the PA Board of Nursing to process the flood of applications).

It is maddening, as a doctoral-prepared NP, that I should have to work with two physician collaborators.  If the Pennsylvania branch of the American Medical Association, who has fought this break in antiquated wink-wink boys’ club tradition was so concerned about the health of Pennsylvanians they would have jumped in to break the collaboration and made physicians available via a hotline to support what they call “mid-level” practitioners.  Instead millions have been wasted on both sides and years have gone by while tragically underserved Pennsylvanians, my neighbors, people I know and have heard of via word of mouth, have suffered with no access to care.  No. Access.  To.  A.  Medical.  Doctor.  Or.  NP.

There are plenty of patients who prefer a board certified physician.  And I have learned under and alongside wickedly intelligent physicians to whom I will always be grateful.  But there are also patients who love NPs and welcome our prevention as well as treatment modality.  There is enough room for everybody.  We should respect each other. Stop throwing verbal stones.  However, aside from that, get rid of the collaboration agreement.  And once that is done, fix this new, upcoming law because even when it is passed, Pennsylvania’s collaboration will remain the most antiquated in the entire 50 states.  And that, my dear friends, is unacceptable.

 

Job Search & Networking

This week I attended a national conference for nurse practitioners (NCNP 2017).  The original intent was to learn the newest guidelines on common ailments I encounter in primary care practice. However, with recent events, I found myself in need of networking to see about locating a new employer.  Here’s what I found…

Being outright honest about why I parted ways with my previous employer was refreshing to both parties.  I did not bash the folks I used to work for.  Instead, I quickly noted our disagreement and stated I enjoyed working for the previous company and would miss them but things did not work out as I had hoped.  It was truthful and heartfelt.  Speaking negatively about a previous employer, even when, by many accounts is could have been justified, would have been poor form.  It is not in my character.  My grandfather used to tell me the only two things people can’t take away from you are your character and your education.  He was right then and that statement continues to hold true today.

Another thing I found was that the nurse practitioners I met from around the country were engaged in refreshing their knowledge. They enjoyed networking with others regardless of geographic origin as much as I did.  I’ve picked up a few words in another language which has been fun, too.  It is apparent the days in which health care providers earn their license and then practice the same way year after year until they retire some decades later are gone. NPs are vested in their patients’ health and wellness.  That entails constant refresher courses as guidelines for every major and minor disease, ailment, and injury change faster than they can be printed.

It’s been the type of week which reinforces why I became a nurse practitioner.  I have met other NPs who also strive to do the best they can to do right by their patients.  I’ve also picked up clinical pearls, those tid bits of information which successfully guide medical decisions to help my patients recover or cope with medical illnesses.

When I return home tomorrow, I will get on the plane as a better NP, have more friends, and maybe, just maybe, a new job in the pipeline.  I sure do hope so.

If no job materializes, I know God will have the right job waiting at the right time just for me.  It’s kind of like a prescription for medication, follow the right  steps and then wait and in time things will work out just fine.

 

Those who are supposed to care

Sometimes we as health care practitioners (HCPs)are the ones who are ill or injured.  When that occurs, we generally believe the other HCPs around us, and particularly, those whom we work so hard for, will treat us with caring respect. For some HCPs, especially some employers, that is simply not going to happen regardless of the nature of the injury.  Large facility employers have adequate policies in force to protect both the employer from lollygaggers and the employee from heartless owners who purposefully disregard obvious painful, debilitating injuries.  Smaller places of practical care often  have policies which evolve spontaneously, usually to the benefit of the employer.  It is not until times of such disability that employers reveal what type of wizard is truly behind the curtain.

In the course of our employed lives, which accounts for roughly 70% of our time on this earth, realizing that our employer is not the wonderful, caring being we had believed them to be.  The slow realization that the previously beloved employer is focused only on money production can be agonizing.

After much thought, two end products should result when the employees care more about each other than the employer could ever claim in front of the Almighty.  First, the injured practitioner should give swift, adequate, professional notice.  Save yourself.  In order to be the best NP one can be, it is an absolute necessity to care for oneself and about oneself.  Working for any practice that only treats employees well when those employees are, um, well, is like continuing to date someone after they have shown themselves to be untrustworthy.  Save yourself.

The second end result should be to evaluate future employers more carefully.  Weigh smaller versus larger practices.  Ask about written policy handbooks.  And what to expect if policies are overhauled.  Are employees grandfathered?  It is important to know.  Save yourself from jumping too fast. 70% can be a long, long time.

Sadly, finding out how an employer treats injured employees is often something we understand after the process has started.  Worse is that this has to be written about at all.  Our society has become so completely romanticized with the PC of everything that it is difficult to understand how any employer can be so callous as to watch an employee physically suffer day after day and then verbally and policy-driven attack them.

However, if you are genuinely kind, truly and authentically kind to co-workers and patients, rest assured those fine people will be tremendously supportive right through to the last-minute of the last day.  And that, my friends, is why being honest and kind triumphs over hardened money-driven hearts every single time.